POS1454 ARE ULTRASOUND SALIVARY PARENCHYMAL ABNORMALITIES MORE SEVERE IN PRIMARY SJÖGREN PATIENTS WITH A HIGHER DISEASE DURATION? A TRANSVERSAL INTERNATIONAL STUDY
Authors: A. Tison, S. Jousse-Joulin, M. Consigny, P. Moog, B. Hofauer, E. Hachulla, C. Lamotte, J. Morel, G. Mouterde, V. Milic, H. Bootsma, A. J. Stel, B. A. Fisher, M. Maybury, A. Baer, D. Direnzo, H. R. Kim, H. K. Min, S. S. Lee, S. E. Choi, G. Carvajal Alegria, S. Boisramé, D. Guellec, D. Cornec, M. Jonsson, D. Hammenfors, A. Saraux, V. Devauchelle-Pensec
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Salivary gland ultrasonography (SGUS) is commonly used in primary Sjögren Disease (pSD) as a diagnostic tool [1]. It could also be used to monitor disease activity, but severity of SGUS parenchymal abnormalities in relation to disease duration is not well characterized. <h3>Objectives</h3> To assess transversally the severity of ultrasound salivary parenchymal abnormalities in relation to pSD duration. <h3>Methods</h3> In this prospective cross-sectional international multicentric study, patients with pSD according to 2002 or 2016 ACR/EULAR classification criteria were included. Parenchymal abnormalities assessed by ultrasound within both parotid and sub-mandibular glands were reported on a standardized form and classified according to the semi-quantitative score of the OMERACT (global score and each item evaluated separately) [2]. Reliability between experts was measured after online training. Demographic, clinical and paraclinical data were also collected and patients were separated into 4 groups according to disease duration from the first buccal dryness symptoms (group A: &lt; 5 years, group B: between 5 and 10 years, group C: between 10 and 20 years, group D: &gt; 20 years of evolution).The association between disease duration groups and SGUS parenchymal abnormalities was quantified in terms of odds ratio and its 95% confidence interval. <h3>Results</h3> 247 patients were consecutively included between May 2019 and February 2022 in 12 international centers. They were 47, 69, 78 and 53 in groups A, B, C and D, respectively. Women represented 94.7% of patients, with a median age of 58 [range 19-89] years old. Oral and ocular dryness were reported by 99.6% and 95.1% of patients, respectively. Salivary flow was abnormal in 74.7% of patients and Schirmer's test in 82.1%. The focus score was ≥1/4mm2 in 89% of patients. 85% of patients had positive anti-SSA and 59.6% had rheumatoid factor. The median ESSDAI score was 3 [0-48]. Considering for each patient the gland with the highest US OMERACT score, there was a global significant association between disease duration and OMERACT score (OR for 5 years duration: 1.23 [IC95% 1.04; 1.47], p=0.02). When comparing groups A+B versus C+D on the OMERACT score, the OR was 1.95 [IC95% 1.10; 3.46], p=0.02, while no significant difference was found when comparing group A versus B+C+D. Considering each item of the OMERACT score, there was not any statistical difference between the 4 groups in relation to the proportion of an/hypoechoic areas in the gland nor homogeneity or posterior border visibility. The only statistical difference between groups was found regarding the proportion of hyperechoic bands (p = 0.0009). When comparing group A versus B+C+D on this item, the OR was 2.55 [95%CI 1.30-5.01], p=0.006). <h3>Conclusion</h3> This large international transversal study in patients with pSD found a positive association between global SGUS lesions evaluated by the OMERACT score and disease duration, with a significant difference only observed in the proportion of hyperechoic bands, when considering separately each item of the score. This may suggest a progressive fibro-adipous evolution of the gland across disease duration. The presence of diffuse hyperechoic bands (grade 3 in the OMERACT scoring system), corresponding to a higher disease duration group, could be useful in the future to stratify patients in clinical trials and to interpret SGUS modifications after treatment. <h3>References</h3> [1]Jousse-Joulin S, Gatineau F, Baldini C, Baer A, Barone F, Bootsma H, et al. Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for Primary Sjögren's syndrome. J Intern Med. 2020 Feb;287(2):180–8. [2]Jousse-Joulin S, D'Agostino MA, Nicolas C, Naredo E, Ohrndorf S, Backhaus M, et al. Video clip assessment of a salivary gland ultrasound scoring system in Sjögren's syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Ann Rheum Dis. 2019 Jul;78(7):967–73. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.